Neurosurgery Coding Alert

Question: If our surgeon performs a posterolateral fusion (22612) at the same level as a fusion using posterior interbody technique (22630), can we bill for both? These are two separate approaches, so they would seem to be separate for coding purposes.

Indiana Subscriber

Answer: Payers have vacillated on this point over time. Prior to 2006, most insurers would allow separate payment for posterolateral fusion (22612, Arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) and posterior interbody fusion (22630, Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace [other than for decompression], single interspace; lumbar) for the same level at the same time.

In early 2006, however, version 12.1 of the national Correct Coding Initiative (CCI) introduced an edit bundling 22630 into 22612. The logic, seemingly, was that the posterolateral fusion was fairly minor when done at the same level as an interbody fusion, and therefore did not add significant additional effort or require additional payment.

Many surgeons took issue with this new bundle, however, and with the cooperative aid of the American Association of Neurological Surgeons, Congress of Neurological Surgeons, North American Spine Society and other advocacy groups argued successfully that although they may combine the procedures to combat extreme structural instability and/or for the ablation of a degenerative disc, the surgeries do occur in two separate areas of the spine and should be considered separate. CMS retracted the edit bundling 22630 into 22612 in CCI version 12.3, and even offered to pay any claims for that code combination that Medicare had previously rejected.

Bottom line: You are free once again to report 22630 and 22612 when the surgeon performs both a posterolateral fusion and a posterior interbody fusion. As long as documentation supports that both procedures occurred and each was supported by documentation, payers should reimburse you for both services.